Average Medicaid Office Visit Payments
Typical Medicaid Office Visit reimbursement across 14,934 cities
Avg. Medicaid Paid
$51.55
Price Range
$0.00 – $907.39
Total Claims
1469.2M
Cities
14934
Typical Payment Range
Typical Medicaid Office Visit payments fall between $29.28 and $67.92 per claim (median: $46.55). The top 10% of payments exceed $95.29.
Based on per-provider averages across all Medicaid claims in this category.
About This Procedure
A standard doctor's office visit for evaluation and management of medical conditions. Includes new patient visits, follow-up visits, and consultations.
Why do these costs look low?
These figures represent Medicaid reimbursement rates — the amounts that state Medicaid programs actually paid providers. Medicaid typically reimburses significantly less than private insurance or out-of-pocket prices. If you have private insurance or are paying cash, expect higher costs. See the cost components below for per-code averages.
Costs by City
| City | Avg. Paid | Min / Max | Claims | Providers |
|---|---|---|---|---|
| La Fayette, NY | $42.01 | $35.72 – $102.39 | 3,326 | 2 |
| Lebanon Junction, KY | $31.46 | $31.46 – $31.46 | 3,330 | 1 |
| Piedmont, CA | $23.14 | $7.80 – $44.76 | 3,331 | 3 |
| New Milford, NJ | $19.84 | $10.98 – $249.60 | 3,333 | 7 |
| Hickory Valley, TN | $16.80 | $16.80 – $16.80 | 3,334 | 1 |
| Lansdowne, PA | $59.00 | $14.86 – $69.69 | 3,335 | 4 |
| Vardaman, MS | $102.16 | $29.31 – $125.44 | 3,340 | 2 |
| Burke, SD | $88.98 | $88.98 – $88.98 | 3,341 | 1 |
| Copperopolis, CA | $21.96 | $21.68 – $95.77 | 3,342 | 2 |
| Lake Park, NC | $75.76 | $72.82 – $81.86 | 3,343 | 2 |
| Johnson, KS | $110.31 | $23.67 – $120.71 | 3,343 | 3 |
| Williamston, MI | $60.40 | $28.43 – $86.95 | 3,343 | 3 |
| Rickman, TN | $30.94 | $30.94 – $30.94 | 3,346 | 1 |
| Whitsett, NC | $42.95 | $22.35 – $54.98 | 3,350 | 7 |
| Chattaroy, WV | $0.10 | $0.10 – $0.10 | 3,350 | 1 |
| Eubank, KY | $38.14 | $38.14 – $38.14 | 3,351 | 1 |
| Mary Esther, FL | $65.38 | $6.91 – $68.42 | 3,351 | 5 |
| Graham, TX | $23.81 | $0.00 – $63.51 | 3,352 | 12 |
| Glenshaw, PA | $38.51 | $36.12 – $45.02 | 3,353 | 5 |
| Windsor, MA | $41.53 | $41.53 – $41.53 | 3,354 | 1 |
| Buffalo, TX | $27.30 | $26.28 – $37.45 | 3,355 | 4 |
| Stevenson, WA | $20.98 | $0.00 – $22.71 | 3,359 | 3 |
| Marrieta, CA | $6.43 | $6.43 – $6.43 | 3,359 | 1 |
| Newport, NC | $29.86 | $13.93 – $65.31 | 3,363 | 5 |
| Sabana Seca, PR | $0.80 | $0.00 – $0.88 | 3,367 | 2 |
| Limon, CO | $15.77 | $0.00 – $63.81 | 3,370 | 7 |
| Jefferson, SC | $150.01 | $58.64 – $194.61 | 3,372 | 3 |
| Curtis Bay, MD | $97.67 | $97.67 – $97.67 | 3,373 | 1 |
| Charleston, TN | $42.70 | $23.12 – $47.87 | 3,374 | 4 |
| Beulah, MI | $41.00 | $7.94 – $68.86 | 3,376 | 2 |
| Johnsonburg, PA | $69.49 | $11.48 – $91.28 | 3,380 | 2 |
| Chetek, WI | $28.21 | $17.81 – $85.15 | 3,384 | 4 |
| Rockville Center, NY | $79.13 | $68.12 – $84.77 | 3,384 | 2 |
| Athens, PA | $73.21 | $30.57 – $85.84 | 3,386 | 3 |
| Warner, NH | $41.37 | $33.27 – $42.94 | 3,386 | 4 |
| French Lick, IN | $37.86 | $37.51 – $41.38 | 3,386 | 2 |
| Pinetops, NC | $84.44 | $17.92 – $181.22 | 3,387 | 4 |
| W Yarmouth, MA | $41.91 | $40.78 – $46.88 | 3,388 | 3 |
| Broadway, NC | $37.56 | $33.54 – $44.64 | 3,389 | 2 |
| Arcola, IL | $51.66 | $50.02 – $56.24 | 3,390 | 2 |
| Aubrey, TX | $5.43 | $0.94 – $170.23 | 3,391 | 2 |
| New London, OH | $40.80 | $40.80 – $40.80 | 3,392 | 1 |
| Theresa, NY | $62.38 | $62.38 – $62.38 | 3,394 | 1 |
| Buckley Afb, CO | $74.79 | $68.82 – $108.30 | 3,394 | 4 |
| Graniteville, SC | $44.45 | $31.98 – $60.93 | 3,395 | 3 |
| Salado, TX | $46.18 | $25.18 – $51.45 | 3,395 | 8 |
| New Bremen, OH | $39.95 | $21.66 – $106.09 | 3,396 | 6 |
| Fennville, MI | $0.97 | $0.97 – $0.97 | 3,396 | 1 |
| Schwenksville, PA | $28.17 | $6.78 – $46.70 | 3,399 | 4 |
| Henry, IL | $37.96 | $0.00 – $51.49 | 3,400 | 3 |
Cost Components
National averages for each billing code in this procedure category. Sorted by claim volume.
| Code | Description | Avg. Paid | Claims | Providers |
|---|---|---|---|---|
| 99213 | Office visit established mod | $43.18 | 764,306,590 | 487,602 |
| 99214 | Office visit established mod-hi | $59.53 | 502,480,931 | 466,856 |
| 99212 | Office visit established low | $41.69 | 92,299,154 | 127,462 |
| 99203 | Office visit new moderate | $67.55 | 47,756,882 | 127,334 |
| 99211 | Office visit established minor | $39.24 | 44,127,221 | 47,748 |
| 99204 | Office visit new moderate-high | $92.03 | 32,379,031 | 111,937 |
| 99215 | Office visit established high | $93.58 | 29,619,773 | 74,725 |
| 99202 | Office visit new low | $58.57 | 9,372,712 | 35,486 |
| 99205 | Office visit new high | $136.10 | 3,665,382 | 19,737 |
| 99244 | Office consultation mod-high | $118.25 | 3,405,681 | 11,884 |
| 99243 | Office consultation moderate | $78.55 | 2,585,480 | 8,432 |
| 99245 | Office consultation high | $132.29 | 645,300 | 3,046 |
| 99242 | Office consultation low | $58.27 | 483,445 | 1,980 |
| 99241 | Office consultation brief | $66.15 | 295,664 | 712 |
These averages group common billing codes used when providers bill Medicaid for this procedure. Individual costs will vary.